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Trick or Treat!

by James E. Ginda, MA, RRT, FAARC

A month or so ago, while out enjoying the last days of summer, you felt it. For a time the air suddenly seemed cooler and the wind was more brisk. It was the first realization that summer was winding down, and a hint of the upcoming change in seasons. The kids headed back to school and then the Halloween displays appeared in the stores.

But now the end of October is near. “Trick or Treat” will soon be heard at our doors — the voices of happy children celebrating in creative costumes.

What are the challenges of enjoying Halloween for a child with asthma? With a few Halloween tricks we can turn the occasion into a treat!

Trick number one: asthma control

The first trick with asthma is keeping it under control.

The lungs of an asthmatic are more reactive to certain stimuli, or things that might cause asthma symptoms such as tightness in the chest, wheezing, coughing, or shortness of breath. Perhaps in the summer there were symptoms on poor air quality days, when ozone levels were higher.

Different seasons bring different common triggers. With allergic asthma, ragweed pollen prevalence in the fall is one example. Regular medical checkups, having the proper medications and teaching, and having an individualized asthma treatment plan are all essential to good asthma control. So before you head out to trick or treat, make sure your child is following all of the recommendations given to you by your physician.

Trick number two: rescue inhaler

When asthma suddenly gets out of control and causes symptoms, it may be referred to as an asthma attack. It is really a flare up of a chronic condition, caused by exposure to a trigger. Something causes a sudden narrowing of the airways that makes breathing more difficult.

For times such as this, the second trick is to make a rescue inhaler accessible to an asthmatic child who has been properly taught how to use it. For younger children, those accompanying the children while trick or treating should carry the inhaler with them. Other inhalers that are controllers should be left at home to avoid confusing them in the dark.

A rescue inhaler contains a quick-relief medication such as albuterol. These quick-relievers do not control asthma, but can provide rapid relief to rescue a child from an asthma attack. This is important because sometimes it is difficult to avoid certain triggers, and an asthma attack results.

For more severe allergic reactions, sometimes an epinephrine injection device is prescribed, and if prescribed it should be readily available. For example, visits to apple orchards are part of fall fun, but apple trees may attract bees, even late in the season. For those with asthma or severe reactions to bee stings or other allergens, these types of rescue medications can be lifesaving.

Trick number three: environmental triggers

The third trick is to be aware of common environmental triggers, because an ounce of prevention is worth a pound of cure.

Halloween costumes are often stored in homes and may be passed on to family members and to others as they are outgrown. Even new costumes are in storage between seasons. As they sit in storage these costumes can collect dust, and dust mites are a common asthma trigger.

Sometimes there are damp conditions in storage areas as well, such as in basements. This can favor growth of visible or hidden mold, which can also be an asthma trigger. If possible, wash the costume first before wearing it, or choose a new costume that can be laundered first. Avoid costumes that are dusty, have even a faint mildew smell, and cannot easily be washed.

Mold spores can also be prevalent in the fall environment due to the dampness of fallen leaves. Wet leaves on the ground can favor mold growth, and when they are kicked up as we walk through them, mold spores can become airborne and be inhaled.

Pumpkins and pumpkin patches are a big part of autumn decorations and fun, but can also be a source of mold as the pumpkins break down over time. When pumpkins are carved into the great Jack O’ Lanterns lighting the evenings of the season, the inside is exposed and they can become moldy. Remove the lid and check the inside occasionally. If moldy, bring them outside or throw them away to preserve indoor air quality.

Indoor air quality is especially important as the days grow shorter and colder, and more time is spent inside. Take care to avoid environmental tobacco smoke, which can be an asthma trigger as well. This is a consideration when taking children to the homes of relatives or friends to show off their costumes. If there are smokers in the home, perhaps trick or treating at the door and getting pictures outside can help avoid exposure for an asthmatic child, yet still allow for great memories to be created.

Trick number four: food allergies

The last trick is to carefully examine the treats your child received to be certain any food allergies are taken into consideration before consumption. For example, candy may contain allergens such as peanuts. When in doubt, throw it out!

Keep Halloween a treat

Learning the tricks of the season can help keep Halloween a treat for children with asthma. Begin by keeping asthma well-controlled. Sometimes controller therapy needs to be stepped up at different times of the year when certain pollens or conditions are prevalent, but a rescue inhaler should be available for quick relief of symptoms should an asthma attack occur. Avoid common triggers such as dust mites, mold, and environmental tobacco smoke, and be extra careful with the goodies when there are food allergies involved. If an epinephrine injector has been prescribed, be sure to carry that as well.

Celebrate the beauty of nature in the changing of the seasons, and make hearing “trick or treat” a happy time for all.